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MR #17.03: Revised Medical Program Standards for 2017

Summary

Effective 01/01/2017, updates the various medical program income standards which are based on the Federal Poverty Level Income Guidelines.

Provides details on the central conversion of Family Health Spenddown coverage to Assist and Moms & Babies coverage.

Provides details on the central conversion of All Kids Premium Level 1-2 cases to Share and Premium Level 1 cases.

Requires the review of All Kids Share cases potentially eligible for Assist due to the change in income standards.

Updates the Program Standards Desk Aid.

Updates the current income thresholds for when a tax dependent, or child of another person in their eligibility determination group (EDG), is expected to be required to file a tax return.

Increase in the Monthly Medical Income Standards

This release places in the manual the revised income standard for the programs listed below based on the 2017 Federal Poverty Level (FPL). The revised standards are effective 01/01/17 for all programs except MPE. The revised MPE standards are effective 2/16/17.

The revised standards will be updated in ACM, IPACS and IES on the first processing day for April 2017 (02/16/17). For pending applications and active cases, the new standards will be applied for any budget month beginning with January 2017.

Monthly Income Standards for AABD, Medicare Cost Sharing

Family Assist and Family Health Spenddown Standards

There is no change in the Family Assist and Family Health Spenddown standards. Children and pregnant women who qualify for spenddown must spend down to the Family Health Spenddown standard.

Central Conversion of FHP Spenddown to Coverage

Family Health Spenddown cases that no longer have a spenddown due to the increase in the monthly income standards for 2017 will be centrally converted to Assist coverage effective 04/2017. Only cases that have been opened or redetermined within the past 12 months will be centrally converted.

For pregnant women with an Expected Delivery Date (EDD) of 02/2017 or later, who are age 19 or older and have income equal to or less than the revised Moms & Babies standard, Code A is entered in Item 78. If there is a TPL entry in Item 79 with an alpha code A through E, code 1 is entered in Item 68. When the entire case is converted, item 80 code 390 SPD will be centrally deleted. If present, code 396 END SPD is also deleted.

For each person under age 19 with income equal to or less than the revised Assist standard, code R is entered in Item 78.

CN 17.01/CN 17.01S is being sent to all cases when at least one person is centrally converted on 03/15/17, effective April 2017. A one-time Mobius report will be generated listing the cases that were centrally converted from spenddown to Assist. The report will be sorted by FCRC and caseload. Look for reports #845051183 Person in Spenddown Converted to Assist or #845051184 for the statewide summary.

Central Conversion of All Kids Premium Cases

All Kids Premium Level 1 cases that qualify for Share due to the increase in the monthly income standards for 2017 will be centrally converted to Share coverage effective 04/2017. Item 80 code 192 PREM will be centrally deleted, Item 73 will be updated from Z to Y or L to J and the program name display in ACID will be centrally updated.

All Kids Premium Level 2 cases that qualify for Premium Level 1 due to the increase in the monthly income standards for 2017 will be centrally converted to Premium Level 1 effective 04/2017. Item 80 code 192 PREM and the program name display in ACID will be centrally updated.

CN 17.02/CN 17.02S is being sent to all cases when at least one person is centrally converted on 03/15/17 effective April 2017. A one-time Mobius report will be generated listing the cases that were centrally converted from Premium Level 1 or 2 to Premium Level 1 or Share. The report will be sorted by FCRC and caseload. Look for reports #84505273 Central Conversion of All Kids Premium Cases or #84505274 for the statewide summary.

Review of Cases Potentially Eligible for Assist

On or about 03/15/17, a one-time Mobius report will be generated listing the All Kids Share cases that may qualify for Assist due to the increase in the monthly income standards. Offices that have cases appearing on this list are to review the Share cases for Assist eligibility. If eligible, cancel the Share case then open an Assist case.

Note:Although Share cases are maintained by the All Kids Unit (LO 180), this report may contain DHS FCRC cases which have not been transferred to LO 180. Look for report #84505281, Potentially Assist Eligible All Kids Share Cases.

Program Standards Desk Aid

The Program Standards Desk Aid in WAG 25-03-02 has been updated with the revised income standards.

Income Thresholds for a Tax Dependent Who May be Expected to be Required to File a Tax Return

The income amounts used to determine whether a tax dependent may be required to file a tax return using modified adjusted gross income (MAGI) budgeting in the 2017 calendar year are based on IRS rules for the 2016 tax year. The income thresholds did not change for the 2016 tax year; therefore there is no change in the IES thresholds to budget the income of a child/stepchild of another person in the EDG, or the income of a tax dependent, when that person's: